DMHC COVID-19 Response

COVID-19 is a new illness that can affect your lungs and airways. It's caused by a virus called coronavirus.

The DMHC is taking action to protect consumers’ health care rights and ensure a stable health care delivery system during this pandemic. The Department is working closely with state and local leaders, health plans, providers and other stakeholders in supporting actions to mitigate the spread and severity of COVID-19.

If you are a health plan enrollee experiencing a problem with your health plan, please visit the DMHC Help Center online or by calling 1-888-466-2219.

State Resources & Actions:

If you do not have a source of health care coverage or have recently lost your employer-sponsored health care coverage, this fact sheet provides and an explanation of some options to gain health care coverage. Contact the specific programs for more information.

Governor Gavin Newsom signed an executive order to expand protections to medical providers as they amplify the use of video chats and similar applications to provide routine and non-emergency medical appointments in an effort to minimize patient exposure to COVID-19. The executive order allows health care providers to use video chats and applications to provide health services without risk of penalty, and aligns with federal Health and Human Services guidelines and waivers issued in response to COVID-19.

DMHC Actions:

The DMHC issued Frequently Asked Questions (FAQs) to clarify health plans must cover COVID-19 tests that are FDA approved or authorized, or approved by the state, without prior authorization and at no cost to the enrollee.

The DMHC directed health plans with commercial lines of business to submit an informational filing explaining the steps the plan has taken, and/or will take, to ensure continued network adequacy. Health plans have an on-going duty to ensure they have adequate networks to provide enrollees with all medically necessary services in a timely and geographically appropriate manner. Providers, including medical and dental clinics and hospitals, report experiencing significant financial difficulties due to COVID-19, as patients have delayed receiving all but emergency and urgent medical services.

Due to the COVID-19 state of emergency the DMHC is extending the end of the phase-out period through October 31, 2020. Beginning November 1, 2020, health plans may not renew large group coverage for small employers or individuals, regardless of the arrangement by which the small employer or individual purchased the coverage.

The DMHC has modified the start date for the Timely Access Provider Appointment Availability Surveys (PAAS) for Measurement Year (MY) 2020 due to the COVID-19 pandemic. Health plans shall begin administration of the MY 2020 PAAS no earlier than August 1, 2020.

The DMHC has extended the phase-in period under the General Licensure Regulation, adopted in 2019. The All Plan Letter extends the phase-in period through December 31, 2020 due to the uncertainty caused by the COVID-19 pandemic. The DMHC has also updated the guidance document to reflect the extended phase-in period.

The DMHC and California Department of Aging (CDA) issued an All Plan Letter (APL) to offer reminders and resources to help health plans serve enrollees who are aged 60 and older, or have high-risk health conditions during the COVID-19 emergency response. During California’s stay-at-home order, older Californians and other at-risk adults will likely need the help of their health plans, as well as family, friends, neighbors and community, to help them maintain basic needs like groceries and prescriptions, and much-needed social interaction and connection.

In light of the COVID-19 State of Emergency, the DMHC has determined that select deadlines and requirements may be temporarily extended to give health plans additional time to comply. The extensions enumerated in the DMHC All Plan Letter (APL) shall be in effect until the California Governor declares the COVID-19 State of Emergency no longer exists or the DMHC notifies health care service plans that the extensions permitted in this APL are no longer in effect.

DMHC APL 20-015 – COVID-19 Temporary Extension of Plan Deadlines

DMHC and the Office of the Surgeon General (OSG) offer reminders and resources to help health care service plans serve enrollees and mitigate negative health outcomes to members due to the COVID-19 emergency. To mitigate negative secondary health outcomes, it is crucial that health care service plans and their providers continue to provide high-quality care to enrollees.

The DMHC issued an All Plan Letter (APL) in March directing health plans to ensure Californians can access necessary medical care through telehealth when medically appropriate. This includes directing health plans to reimburse providers for care provided through telehealth at the same rate as in-person care and ensuring enrollee cost-sharing is not changed for telehealth services. Following several questions from plans and providers, the DMHC issued All Plan Letter (APL) 20-013 - Billing for Telehealth Services; Telehealth for the Delivery of Services with a Frequently Asked Questions (FAQ) document. This includes information on provider billing during the COVID-19 State of Emergency to decrease administrative burdens on providers and plans.

The Departments of Health Care Services (DHCS), Public Health (CDPH), and Managed Health Care (DMHC) continue to closely monitor and assess appropriate next steps as well as release guidance to ensure the safety of Medi-Cal beneficiaries, health plan enrollees, medical providers, and California communities in general.

The State of California understands that people with disabilities are concerned that medical providers might consider an individual’s disability status when determining which patients to treat if hospitals or other health care facilities experience a surge of patients needing life-saving care. This joint bulletin reminds health care providers and payers that rationing care based on a person’s disability status is impermissible and unlawful under both federal and state law.

As the state of California is taking action to respond to the COVID-19 pandemic, the Department of Managed Health Care (DMHC) joined with Covered California and the Department of Health Care Services to make sure Californians have a ready path to health care coverage.

The DMHC provided guidance to health plans on the special-enrollment period, including on and off-exchange health plans. This will ensure consumers enrolling in the entire individual market in California will have access to coverage during the pandemic emergency.

“We are working together to protect the health and safety of Californians during this pandemic,” said DMHC Director Shelley Rouillard. “This includes making sure that Californians are able to access health care coverage. Opening a special-enrollment period due to COVID-19 offers new coverage options to Californians when they need it most.”

The Department of Managed Health Care (DMHC) issued an All Plan Letter encouraging health plans take actions to facilitate the delivery of health care services in a manner that decreases the need for in-person visits and practices “social distancing” measures to help slow the spread of COVID-19. This includes expanding health care delivery via telehealth and decreasing the need for in-person pharmacy visits.

Under the direction of Governor Gavin Newsom, the Department of Managed Health Care (DMHC) issued an All Plan Letter directing all full-service commercial and Medi-Cal plans regulated by the Department to immediately reduce cost-sharing to zero for all medically necessary screening and testing for the novel coronavirus (COVID-19). This includes waiving cost-sharing for emergency room, urgent care or provider office visits when the purpose of the visit is to be screened and tested for COVID-19. The need for COVID-19 testing is based on medical necessity, a clinical determination made on a case by case basis by medical professionals.